This study aimed to investigate the predictive value of the red cell distribution width-to-platelet ratio (RPR) for cardiac surgery-associated acute kidney injury (CSA-AKI). A retrospective analysis of clinical data from 252 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Patients were classified into AKI (n = 136) and non-AKI (n = 116) groups based on the Kidney Disease: Improving Global Outcomes (KDIGO) consensus criteria. Baseline creatinine was defined as the last measurement obtained before surgery. For the first seven days postoperatively, patients underwent sequential assessments of complete blood counts, hepatic function, and renal function. For the analysis, we used the laboratory values collected on the day immediately preceding the onset of AKI. Missing values were addressed using simple imputation. Continuous variables with an approximately normal distribution were imputed with their mean, whereas skewed variables were imputed using the median. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value, and the area under the curve (AUC) was applied to compare predictive ability among different indices. Clinical outcomes revealed significantly higher RPR levels in the AKI group compared to the non-AKI group (14.94 vs. 8.46, p < 0.001), with elevated RPR independently associated with AKI risk(Odd Ratio = 1.433, 95

BACKGROUND:Recently, marginal donor hearts have been applied to patients with end-stage heart failure due to rising waiting list mortality and increasing demand for donors. However, the principles of risk prevention and the usage of marginal donor hearts have yet to be clearly defined. METHODS:A retrospective analysis was performed to investigate the outcomes of patients undergoing heart transplantation at our center between October 2019 and March 2024. Forty-four patients were enrolled and divided into the marginal donor heart group (n = 30) and the conventional donor heart group (n = 14) according to the classification criteria. The clinical data between the 2 groups were compared and analyzed. RESULTS:There were no statistically significant differences in the postoperative length of hospitalization, ICU stay, left ventricular ejection fraction, or serum biochemical indicators between the 2 groups. Five patients died during the 3-month follow-up period. Notably, 1- and 3- month postoperative follow-up showed no significant differences in left ventricular ejection fraction, serum biochemical indicators, and mortality between the 2 groups CONCLUSION: The application of marginal donor hearts can partially alleviate the shortage of donor heart resources. It did not significantly affect patients' short-term survival or recovery.

The incidence of Mycobacterium tuberculosis (Mtb) infection in patients with mechanical circulatory support devices is extremely rare. We present a case involving a 38-year-old male who experienced a delayed sternal Mtb infection following left ventricular assist device (LVAD) implantation. More than 5 months post-surgery, the patient was readmitted to the hospital presenting a subxiphoid abscess. The incision site displayed an unsatisfactory healing process after the incision and drainage of the abscess. Despite engaging in a rigorous treatment protocol, which included anti-infective therapy, vacuum-assisted closure, and surgical debridement, the patient's wound remained unhealed. Ultimately, after pus gene sequencing confirmed the diagnosis, the patient was administered a regimen combining anti-tuberculosis and anti-infective therapy, which culminated in the successful healing of the wound. This singular case study not only reveals the clinical progression of an unexpected Mtb infection post-implantation but also emphasizes the challenges encountered in diagnosis and management.

OBJECTIVE:To assess the effect of different antiplatelet strategies on clinical outcomes after coronary artery bypass grafting.DESIGN:Five year follow-up of randomised Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Grafting (DACAB) trial.SETTING:Six tertiary hospitals in China; enrolment between July 2014 and November 2015; completion of five year follow-up from August 2019 to June 2021.PARTICIPANTS:500 patients aged 18-80 years (including 91 (18.2%) women) who had elective coronary artery bypass grafting surgery and completed the DACAB trial.INTERVENTIONS:Patients were randomised 1:1:1 to ticagrelor 90 mg twice daily plus aspirin 100 mg once daily (dual antiplatelet therapy; n=168), ticagrelor monotherapy 90 mg twice daily (n=166), or aspirin monotherapy 100 mg once daily (n=166) for one year after surgery. After the first year, antiplatelet therapy was prescribed according to standard of care by treating physicians.MAIN OUTCOME MEASURES:The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularisation), analysed using the intention-to-treat principle. Time-to-event analysis was used to compare the risk between treatment groups. Multiple post hoc sensitivity analyses examined the robustness of the findings.RESULTS:Follow-up at five years for major adverse cardiovascular events was completed for 477 (95.4%) of 500 patients; 148 patients had major adverse cardiovascular events, including 39 in the dual antiplatelet therapy group, 54 in the ticagrelor monotherapy group, and 55 in the aspirin monotherapy group. Risk of major adverse cardiovascular events at five years was significantly lower with dual antiplatelet therapy versus aspirin monotherapy (22.6% v 29.9%; hazard ratio 0.65, 95% confidence interval 0.43 to 0.99; P=0.04) and versus ticagrelor monotherapy (22.6% v 32.9%; 0.66, 0.44 to 1.00; P=0.05). Results were consistent in all sensitivity analyses.CONCLUSIONS:Treatment with ticagrelor dual antiplatelet therapy for one year after surgery reduced the risk of major adverse cardiovascular events at five years after coronary artery bypass grafting compared with aspirin monotherapy or ticagrelor monotherapy.TRIAL REGISTRATION:NCT03987373ClinicalTrials.gov NCT03987373.

PurposeThe objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).MethodsThis is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C <1.8, 1.8–<2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke, and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2–6.1) years.ResultsDuring the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8–<2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with the postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in the LDL-C 1.8–<2.6 mmol/L group [adjusted hazard ratio (aHR) = 1.92, 95% CI, 1.12–3.29; P = 0.019] and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29–6.64; P < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with an increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06–2.18; P = 0.022).ConclusionsFor CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.

目的 研究接受ECMO治疗患者死亡的危险因素及列线图预测模型构建.方法 回顾性纳入2018年4月至2022年6月间连续412例急性心和(或)肺功能衰竭患者,接受ECMO治疗的临床资料,根据患者院内存活情况,应用单因素相关分析,选出危险因素变量,然后使用Lasso回归筛选全部变量,合并共同变量,与临床实际相结合,绘制列线图对早期死亡概率进行预测,利用ROC曲线(AUC)下面积,Harrell的C指数和校准曲线来评估和内部验证该模型的性能.应用决策曲线分析来评估其临床效用.结果 脑梗死、糖尿病、心肺复苏史、神经系统并发症、急性肾损伤、乳酸、血红蛋白、白蛋白、血小板计数是接受ECMO治疗患者死亡的危险因素(P＜0.05).同时根据实际情况和差异变量,构造了可信度比较高的列线图用来预测死亡概率.结论 本研究明确了接受ECMO治疗患者死亡的危险因素,成功构建并验证了列线图预测模型,为ECMO死亡预测提供了一个简便可靠的工具,对患者的个体化治疗具有重要指导意义.

目的 分析同期心脏瓣膜手术对左心室辅助装置(LVAD)置入患者围手术期心肌和肾功能损伤的影响.方法 纳入2018年5月至2023年3月于郑州大学华中阜外医院接受LVAD置入的终末期心力衰竭(心衰)患者17例,根据是否同期行心脏瓣膜手术分为单独LVAD组(3例)和伴随手术组(14例).采用重复测量方差分析比较两组患者围手术期心肌损伤酶学标志物和肾功能指标变化,比较两组并发症及手术相关资料.结果 两组术前、术后1周、术后1月肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、超敏肌钙蛋白(Hs-cTnT)、N端-B型钠尿肽前体(NT-proBNP)、血肌酐(Scr)和肾小球滤过率(eGFR)比较差异均无统计学意义(P>0.05).单独LVAD组术前、术后1周、术后1月CK-MB、Mb、Hs-cTnT、NT-proBNP、Scr和eGFR两两比较差异均无统计学意义(P>0.05).伴随手术组两两比较结果显示,与术前相比,术后1周CK-MB、Mb、NT-proBNP和Scr升高差异均无统计学意义(P>0.017),Hs-cTnT升高和eGFR降低差异有统计学意义(P<0.01),术后1月CK-MB、Mb、Hs-cTnT、NT-proBNP和Scr升高和eGFR降低差异均无统计学意义(P>0.017);与术后1周相比,术后1月Mb、Hs-cTnT、Scr降低和eGFR升高差异有统计学意义(P<0.017).两组手术时间、机械通气时间、ICU停留时间和术后住院时间比较差异均无统计学意义(P>0.05).与单独LVAD组相比,伴随手术组术中出血量、体外循环时间、主动脉阻断时间增加差异有统计学意义(P<0.05),但两组住院期间死亡、并发症发生情况比较差异均无统计学意义(P>0.05).结论 LVAD置入同期行心脏瓣膜手术可能不会造成严重的心肌缺血性损伤和肾损伤,不会显著增加围手术期死亡率和并发症发生率.

目的:探讨定量血流分数指导冠脉中度狭窄病变血运重建的近期临床效果.方法:收集2020年9月至2021年12月于阜外华中心血管病医院由同一医师组手术、且术前冠脉造影提示存在中度狭窄病变的83例患者的临床数据,根据血运重建方案制定的依据分为QFR指导组(40例)和CAG指导组(43例).比较两组的围手术期和术后6个月临床资料,进行回顾性分析.结果:QFR指导组术中吻合血管支数明显少于CAG指导组(P<0.05),QFR指导组的术后呼吸机使用时间、监护室滞留时间、术后住院时间均短于CAG指导组(P<0.05).两组在围术期不良事件发生率和术后6个月随访中主要不良心血管事件发生率方面,无明显差异(P>0.05).结论:通过定量血流分数分析,为冠脉中度狭窄病变患者制定手术方案是安全、有效的,减少了不必要的血运重建,简化了手术方式,缩短了整体术后住院时间,节约了医疗成本,更符合精准化外科治疗的需求.

The prevalence of heart failure(HF) is increasing worldwide, and mitral regurgitation(MR) is a common manifestation in patients with end-stage HF. Currently, the indications for concomitant surgical intervention of significant preoperative MR during left ventricular assist device(LVAD) implantation are still controversial. Based on discussing the etiology, classification, and pathophysiology of functional MR in patients with end-stage HF, this paper reviews the relevant factors affecting the prognosis of such patients and the progress of research related to whether to perform mitral valve surgery to intervene in significant MR during LVAD implantation, to provide a further reference for clinical practice.

目的 比较70岁以上冠心病患者冠状动脉旁路移植术中采用左乳内动脉(left internal mammary artery,LIMA)、大隐静脉(saphenous vein,SV)作为左前降支桥血管的近期疗效,探讨其安全性.方法 70岁以上冠心病患者254例,均行非体外循环心脏不停跳冠状动脉旁路移植术,术中采用LIMA作为左前降支桥血管者198例为LIMA组,采用SV作为左前降支桥血管者56例为SV组.比较2组性别、年龄、合并症、病史、术前左室射血分数等临床资料;记录2组手术时间、搭桥支数、术后24 h胸腔引流量、ICU停留时间、术后住院时间、输血及术前行颈动脉支架、肾动脉支架手术比率;比较2组院内死亡及术后心肌梗死、脑梗死、恶性室性心律失常、二次开胸止血、胸骨愈合不良发生情况.结果 2组年龄,术前左室射血分数,男性及合并高血压、糖尿病、高脂血症、慢性阻塞性肺疾病、肾功能不全比率,有心肌梗死史、经皮冠状动脉介入治疗史、脑梗死史比率比较差异均无统计学意义(P＞0.05).2组手术均顺利完成,LIMA组手术时间[(260.21±37.09)min]、搭桥支数[(3.80±0.69)支]、术后 24 h 胸腔引流量[(349.52±123.72)mL]、ICU 停留时间[(50.26±14.38)h]、术后住院时间[(11.60±3.66)d]、输血及术前行颈动脉支架、肾动脉支架手术比率(18.69％、3.03％、1.52％)与 SV 组[(255.23±54.09)min、(3.63±0.78)支、(332.59±146.09)mL,(51.98±16.55)h、(11.14±4.87)d、17.86％、3.57％、1.79％]比较差异均无统计学意义(P＞0.05).LIMA组术后心肌梗死发生率(1.01％)低于SV组(7.14％)(x2=4.708,P=0.030),院内病死率及二次开胸止血、脑梗死、恶性室性心律失常、胸骨愈合不良发生率与SV组比较差异均无统计学意义(P＞0.05).结论 70岁以上冠心病患者行冠状动脉动脉旁路移植术采用LIMA作为左前降支桥血管可降低术后心肌梗死发生风险,不增加围术期并发症发生率.

冠状动脉旁路移植术(CABG)在我国不断发展,演变出了诸多临床术式.参考近几年的文献报道和诸多专家经验,现全面总结国内CABG的最新临床术式.从体外循环的应用、手术入路和桥血管材料3个方面对CABG进行分类归纳,论述临床术式的发展现状,比较不同术式之间的差异,讨论临床医师对不同术式的选择倾向,并预测未来CABG在临床术式上的发展和突破方向.

Objective: It remains unclear whether aggressive low-density lipoprotein cholesterol (LDL-C) management (<1.8 mmol/L) can slow the process of vein graft stenosis. This study aimed to explore the impact of baseline LDL-C levels on vein graft patency in patients on ticagrelor with or without aspirin 1 year after coronary artery bypass grafting (CABG). Methods: This was a post hoc analysis of the DACAB (Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery) trial (NCT02201771), a randomized controlled trial (ticagrelor thorn aspirin or ticagrelor vs aspirin) of patients undergoing CABG in China. The study subjects were stratified as LDL-low (baseline LDL-C<1.8 mmol/L, 148 patients with 430 vein grafts) versus LDL-high (baseline LDL-C >= 1.8 mmol/L, 352 patients with 1030 vein grafts). The primary outcome was the 1-year vein graft patency (Fitzgibbon grade A) assessed by coronary computed tomographic angiography or coronary angiography. Results: Baseline/1-year LDL-C were 1.4/1.6 and 2.6/2.4 mmol/L in the LDL-low and LDL-high subgroups, respectively. Regardless of antiplatelet regimen, no significant inter-subgroup difference was observed for 1-year graft patency (LDL-low: 83.8% [359/430 grafts]; LDL-high: 82.3% [848/1030 grafts]; adjusted OR for non-patency [ORadj], 0.96; 95% confidence interval [CI], 0.62-1.50, P = .857). For both subgroups, the 1-year graft patency rates were greater with ticagrelor thorn aspirin versus aspirin (LDL-low: ORadj, 0.41; 95% CI, 0.17-0.97; LDL-high: ORadj, 0.38; 95% CI, 0.20-0.71; inter P = .679). Conclusions: In general, baseline LDL-C is not associated with 1-year vein graft patency after CABG. Regardless of the baseline LDL-C levels, ticagrelor thorn aspirin was superior to aspirin alone in maintaining vein graft patency. The primary factor causing early vein graft disease might not be atherosclerosis but thrombosis.

Background:The influence of baseline HbA1c levels on vein graft outcomes post coronary artery bypass grafting (CABG) remains unclear. Objective:The purpose of this study was to assess the association between baseline HbA1c and 1-year vein graft patency, and the effects of antiplatelet therapy on the 1-year vein graft patency after CABG in patients with baseline HbA1c <6.5% vs ≥6.5%. Methods:We examined the subgroups with baseline HbA1c <6.5% vs ≥6.5% from the DACAB trial (NCT02201771), in which 500 patients were randomly allocated to receive ticagrelor plus aspirin (T+A), ticagrelor alone (T), or aspirin alone (A) for 1 year after CABG. The primary outcome was the vein graft patency (FitzGibbon grade A) at 1 year. Results:A total of 405 patients with available baseline HbA1c data were included in this subgroup analysis. Of them, there were 233 patients (678 vein grafts) with baseline HbA1c <6.5% and 172 patients (512 vein grafts) with baseline HbA1c ≥6.5%. Compared with the HbA1c <6.5% subgroup, the HbA1c ≥6.5% subgroup showed worse 1-year vein graft patency (adjusted odds ratio [OR] for nonpatency: 1.69, 95% confidence interval [CI]: 1.08-2.64). T+A showed higher vein graft patency than A in both HbA1c <6.5% (adjusted OR for nonpatency: 0.34, 95% CI: 0.15-0.75) and HbA1c ≥6.5% subgroups (adjusted OR for nonpatency: 0.45, 95% CI: 0.19-1.09), without an interaction effect (P for interaction = 0.335), whereas T did not show more significant improvement than A in both subgroups. Conclusions:In the DACAB trial, lower baseline HbA1c was associated with higher vein graft patency 1 year after CABG. T+A improved 1-year vein graft patency vs A, irrespective of baseline HbA1c.

目的:探讨女性经乳腺钼靶X线检查发现的乳房动脉钙化(BAC)与冠状动脉CT血管成像(CCTA)诊断的冠心病之间的相关性,评估BAC在女性人群中对冠心病的诊断价值.方法:收集我院2019年1月-2020年12月行双侧乳腺钼靶X线检查与CCTA且检查间隔不超过6个月的217例女性患者资料,分别使用BAC的4分制法与CAD-RADS评分系统对BAC及冠心病进行量化.比较BAC阳性与BAC阴性、冠心病阳性与冠心病阴性组的一般资料,使用单因素与多因素logistic回归分析研究BAC与冠心病的关系.使用Spearman相关性分析评估BCA分级与CAD-RADS分级的相关性.绘制BAC预测冠心病诊断的ROC曲线,计算曲线下面积,评估BAC对冠心病的诊断价值.结果:冠心病患病率为14.75％(32例),BAC阳性患病率为13.36％(29例).冠心病组BAC阳性率较非冠心病组高(P＜0.05).对冠心病影响因素的单因素logistic分析显示,BAC阳性与冠心病相关(OR=13.231,95％CI 5.415～32.326,P＜0.001).在多因素logistic回归分析中,调整传统的冠心病危险因素后,BAC阳性仍与冠心病显著相关,是冠心病的独立危险因素(OR=8.879,95％CI 2.945～26.765,P＜0.001).Spearman 秩相关分析显示,BAC 分级与 CAD-RADS 分级呈正相关(r=0.404,P＜0.001).BAC预测冠心病的曲线下面积为0.720,灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为50.00％、92.97％、55.17％、91.49％、86.64％.结论:在女性人群中发现的BAC是冠心病的独立危险因素,BAC严重程度与冠心病的严重程度呈正相关.BAC在女性冠心病中具有一定的诊断价值.

Cardiac arrest is the fourth stage of sudden cardiac death, which is characterized by the cessation of electrical activity in the heart, rapid circulatory and respiratory failure, and the prognosis is often poor. How to effectively predict cardiac arrest is the key and difficult point in the diagnosis and treatment process. In recent years, the research on the application of early warning scoring system in cardiac arrest has made continuous breakthroughs, from initially formulating a traditional scoring system containing only basic vital signs indicators according to a certain number of samples to continuously increasing and changing indicators, increasing the sample size, and formulating an improved scoring system with better sensitivity and specificity. Nowadays, with the continuous development of electronic information technology, machine learning technology is introduced into the formulation of scoring system, which breaks through the limitations of previous scoring system and has achieved good results in clinic. This article analyzes and compares the relevant research and cutting-edge progress of different early warning scoring systems at home and abroad, and summarizes the research results, gaps and shortcomings. Finally, combined with the relevant policies of graded diagnosis and treatment in China, this paper discusses the development and application direction of cardiac arrest early warning scoring system in the future.

目前心脏瓣膜病合并冠心病的血运重建方法是基于冠状动脉造影的视觉评估,有可能导致不必要的血运重建或推迟必要的冠状动脉干预.血流储备分数是评价冠状动脉血流的特异性功能学指标,近年被广泛用于冠状动脉介入领域,随着血流储备分数技术的不断进步及对冠状动脉功能学评价认识的提高,血流储备分数已应用于心脏瓣膜病合并冠心病患者血运重建中,可简化术式、避免不必要的冠状动脉旁路移植术,改善临床结局.本文就血流储备分数及其衍生技术在心脏瓣膜病合并冠心病患者血运重建中应用的研究进展作一综述.

目的 探讨心血管外科教学案例库在胸心外科专业基地住院医师规范化培训过程中的建设方式和应用效果.方法 2名胸心外科专业基地高年资主治医师和10名住院医师收集、筛选、整理和再加工心血管外科案例教学素材10例,导入网络,建成心血管外科教学案例库.选择2018届、2019届采用心血管外科教学案例库教学的20名住院医师为观察组,2020届、2021届采用传统带教方式教学的23名住院医师为对照组,分别比较两组住院医师在心血管外科轮转2月后的理论考核成绩,并对带教老师的教学水平、教学态度以匿名问卷调查的方式进行满意度调查.结果 观察组的基本知识点掌握、知识应用能力、学科拓展能力和总分均高于对照组,差异有统计学意义(P<0.05).观察组住院医师的教学方法满意度、教师态度满意度、教师理论满意度和总分均高于传统带教模式教学的对照组,差异有统计学意义(P<0.05).而教师技能满意度两组差异无统计学意义(P>0.05).结论 心血管外科教学案例库和创立的教学方式增加了住院医师和临床带教的互动和联系,显著提高胸心外科专业基地住院医师在轮转期间的学习效果,值得推广.

目的 探讨冠心病患者采用左胸前外侧小切口与胸骨下段小切口微创冠状动脉旁路移植术治疗的临床效果及术后并发症发生情况.方法 单纯左前降支病变冠心病患者86例,均行微创冠状动脉旁路移植术治疗,其中采用左胸前外侧小切口入路者48例为左胸前外侧组,采用胸骨下段小切口入路者38例为胸骨下段组,术中均行左乳内动脉与左前降支吻合单支搭桥.比较2组年龄、男性比例、体质量指数、糖尿病、高血压、脑血管病史、NYHA心功能分级及术前肌红蛋白、血肌酐水平等临床资料;比较2组手术切口长度、术中出血量、桥血管流量、搏动指数、手术时间、术后呼吸机使用时间、ICU治疗时间、术后视觉模拟疼痛评分、术后住院时间、术后24 h引流量及术后新发心房颤动、切口愈合不良、急性肾损伤、低氧血症并发症发生情况;随访1年,比较2组随访期间桥血管通畅率.结果 2组年龄、体质量指数、男性比例、糖尿病、高血压、脑血管病史、NYHA心功能分级及术前肌红蛋白、血肌酐水平比较差异均无统计学意义(P＞0.05).左胸前外侧组手术切口长度[(7.04±1.03)cm]、术后呼吸机使用时间[(10.56±5.93)h]、ICU治疗时间[(20.05±14.36)h]、术后住院时间[(6.55±2.71)d]均短于胸骨下段组[(10.08±1.12)cm、(13.67±6.36)h、(25.85±7.14)h、(8.06±3.04)d](P＜0.05),术后24 h 引流量[(177.56±131.03)mL]少于胸骨下段组[(268.95±191.02)mL](t=-2.107,P=0.040),术后疼痛视觉模拟评分[(6.24±0.79)分]高于胸骨下段组[(4.86±0.85)分](t=4.564,P＜0.001).2组手术时间、术中出血量、桥血管流量、搏动指数比较差异均无统计学意义(P＞0.05).2组术后均无二次开胸止血、脑血管意外及围手术期心肌梗死情况发生;2组术后新发心房颤动、切口愈合不良、急性肾损伤、低氧血症发生率比较差异均无统计学意义(P＞0.05).随访1年,左胸前外侧组失访3例,胸骨下段组失访2例,左胸前外侧组随访期间桥血管通畅率(97.8％)与胸骨下段组(97.2％)比较差异无统计学意义(x2=0.026,P=0.873).结论 左胸前外侧小切口与胸骨下段小切口微创冠状动脉旁路移植术均可有效治疗单纯左前降支冠状动脉病变冠心病,左胸前外侧小切口手术创伤小,术后恢复快,住院时间短.